Cancer Pain: From Molecules to Suffering
is a one-of-a-kind book in the large collection of publications on the subject of cancer pain management. It is based on presentations delivered at an exceptional research symposium sponsored by the International Association for the Study of Pain. Its 20 chapters, divided into 6 parts, were written by a distinguished international panel of experts and draw upon the most recent laboratory and clinical research focused on cancer pain. Every chapter addresses not only ongoing research endeavors but also their potential clinical implications. This up-to-date information is presented in a reader-friendly format and an easy-to-carry size.

The first part, “Basic Mechanisms of Cancer Pain,” begins with a plea for more basic, translational, and clinical research on chemotherapy-induced neuropathic pain to maximize chemotherapeutic efficacy while minimizing pain associated with cancer treatment. It then covers mechanisms of cutting-edge radiotherapy that can be applied either curatively or palliatively in the treatment of cancer. Colorful illustrations complement the state-of–the-art updates in radiotherapy. The final focus of this part is on bone pain, which is the most common pain in patients with advanced cancer. It discusses pioneering animal models of bone cancer that effectively mirror the clinical presentation of bone pain in humans and could contribute to mechanism-based therapies to alleviate intractable bone pain caused by cancer.

The next part, “Inflammation, Hyperalgesia, and Cancer Pain,” first discusses how cytokine gene variants affect the experience of cancer-related symptoms and response to interventions. For example, tumor necrosis factor-α and interleukins-8 and -6 have been identified as markers for incapacitating symptoms associated with cancer and treatment. The clinical application of antagonists or agonists at certain cytokine receptors might offer benefits of pain relief and effect on tumor growth. The critical linkage between systemic inflammation and cancer pain is reviewed next, and the future of inflammation-targeted therapies to reduce cancer sequelae, such as cachexia pain and depression, is discussed. This part ends with highlights of the current knowledge of the effect of long-term opioid treatment on cancer-induced pain and disease progression. Preclinical studies suggest coadministration of agents, such as cyclooxygenase inhibitors, neurokinin-1 antagonists, and serotonin antagonists, with opioids that may ameliorate the escalation of opioid doses and their adverse effects, including hyperalgesia and analgesic tolerance.

The third part, “Opioid Tolerance,” begins with a description of mechanisms of opioid tolerance by adaptation and desensitization of opioid receptors. The altered equilibrium between pronociceptive and endogenous antinociceptive systems validates the emerging mechanism of opioid-induced hyperalgesia. Some novel approaches for reduction and elimination of opioid tolerance are discussed. Factors associated with failure of opioid therapy and adverse effects in cancer pain management are then explored as is the evidence that “opioid switching” in cancer pain management helps to optimize pain relief and reduce adverse effects. The conclusion of this part introduces innovative treatments that act against opioid tolerance, such as of N
-methyl-d-aspartate receptor antagonists, opioid antagonists, adrenoceptor antagonists, antiopioid peptide antagonists, and inhibitors of glial activation.

Two of the most promising new drugs for cancer pain relief, transient receptor potential vanilloid-1 antagonists and anti-nerve growth factor treatments with human monoclonal antibodies, are discussed at the beginning of part IV, “Clinical Trial Design in Cancer Pain.” Clinical trial design and methodologic issues in studies of pharmacologic treatment of cancer pain are then discussed. The authors propose an international and consensus-based classification tool become a standard in the study of cancer pain. Important and unique methodologic issues for clinical trials of nonpharmacologic interventions in cancer pain are outlined in the final chapter of this part.

The chapters of part V, “Psychology of Cancer Pain: The Basic Research and Clinical Research Agenda,” describe how the psychologic context of cancer greatly affects the entire pain experience, leading to further extraordinary suffering and existential distress. The roles of anxiety, behavioral and cognitive coping, hopelessness, catastrophic pain, and methods of attention management have been thoroughly investigated.

The final part, “Interaction, Education, and Resources,” begins with a clarification of the concept of empathy, “the capacity to allow one's own feelings to be engaged with others, as well as an active and deliberate process of engagement,” in medical settings of cancer treatment and pain management. Even when little can be done to relieve a cancer patient's physical state, such as pain, most of the time something can be offered to help the patient meet his or her psychologic and social needs. A global perspective on cancer pain education for patient and family is then presented followed by a proposal of how to teach students in medicine and health-care professionals about cancer pain. The book concludes with a summary of the obstacles to global relief of cancer pain and exploration of the optimization of resources, including education and medications for cancer pain, needed to meet the needs in the developing world.

The editors of Cancer Pain: From Molecules to Suffering
effectively meet their goal of providing an inspiring and comprehensible text on cancer pain for both clinicians and researchers. The editors are to be congratulated for a book that has impeccable consistency and a seamless transition from bench research to bedside application. This book facilitates the understanding of physiology and pharmacology of cancer pain that can readily be translated into better treatment and satisfactory outcome.

The scope and applicability of this text could be expanded in the next edition. For instance, medical marijuana and cannabinoid receptor agonists for the management of not only cancer pain but also chemotherapy-induced nausea and vomiting in cancer treatment have attracted interest and stirred heated discussion. As another example, although there have been major advances in pharmacotherapy, nonpharmacologic treatment, including complementary and alternative medicine, may offer hope and support in both cancer treatment and pain management.

I highly recommend Cancer Pain: From Molecules to Suffering
to all trainees in pain management as a supplemental text to standard references on pain management. The first three parts may well be selected as topics for journal clubs or clinical symposia. This book can certainly inspire the entire team of health-care professionals in both oncology and pain management. Medical students and resident physicians in not only primary care but also all other specialties could benefit from studying this book in their early stage of training. In addition, many bench and clinical researchers devoted to advance cancer pain management may also find this book and its future editions to be a valuable resource.

David Geffen School of Medicine at University of California, Los Angeles, Santa Monica, California.